Matsukubo Makoto, Sugita Koshiro, Muto Mitsuru, Yano Keisuke, Harumatsu Toshio, Kurimoto Tomonori, Kibe Masaya, Yara Asataro, Ohashi Hiroshi, Yamamoto Tsuyoshi, Hirakawa Eiji, Naito Yoshiki, Nagano Ayaka, Murakami Masakazu, Onishi Shun, Kawano Takafumi, Torikai Motofumi, Tokuhisa Takuya, Ieiri Satoshi
Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8900075, Japan.
Pediatr Surg Int. 2024 Dec 20;41(1):37. doi: 10.1007/s00383-024-05946-z.
Cholestatic liver damage is frequently observed in extremely low-birth-weight infants (ELBWIs) followed by enterostomy. We retrospectively investigated the factors related to liver damage.
ELBWIs who underwent enterostomy at our institution between January 2013 and December 2022 for gastrointestinal disease during the neonatal period were reviewed. Cases presenting with direct bilirubin > 2.0 mg/dl for > 1 month after enterostomy were designated as the prolonged cholestatic liver (p-CL) group and compared with cases without cholestatic liver damage, the (non-CL) group.
Thirty-nine patients (21 in the p-CL group and 18 in the non-CL group) were included. Survival was significantly lower in the p-CL group (52.4% [11/21] vs. 88.9% [16/18]; p = 0.020). Significant differences were found in the birth weight (587.8 g vs. 698.0 g, p = 0.040) and small intestinal length to the enterostomy (47.6 cm vs. 72.8 cm, p = 0.004). Patients in the non-CL group started enteral feeding and reached > 100 ml/kg/day earlier than those in the p-CL group. The length of time with parenteral nutrition was an independent risk factor for prolonged cholestasis (p = 0.02).
The birth weight and stoma site level may affect time with PN and enteral feeding management, subsequently resulting in prolonged cholestatic liver damage in ELBWIs with high prematurity.
极低出生体重儿（ELBWIs）行肠造口术后常出现胆汁淤积性肝损伤。我们回顾性研究了与肝损伤相关的因素。
对2013年1月至2022年12月在我院因新生儿期胃肠道疾病行肠造口术的ELBWIs进行回顾性分析。将肠造口术后直接胆红素>2.0mg/dl持续>1个月的病例定为延长胆汁淤积性肝病（p-CL）组，并与无胆汁淤积性肝损伤的病例（非CL组）进行比较。
共纳入39例患者（p-CL组21例，非CL组18例）。p-CL组的生存率显著较低（52.4%[11/21]对88.9%[16/18]；p=0.020）。出生体重（587.8g对698.0g，p=0.040）和造口处小肠长度（47.6cm对72.8cm，p=0.004）存在显著差异。非CL组患者比p-CL组患者更早开始肠内喂养并达到>100ml/kg/天。肠外营养时间是延长胆汁淤积的独立危险因素（p=0.02）。
出生体重和造口部位水平可能影响肠外营养时间和肠内喂养管理，进而导致极早早产的ELBWIs出现延长的胆汁淤积性肝损伤。
